Creative nonfiction writings and ruminations of a Family Physician. Much of this will be medical musing, patient and doctor stories, but I reserve the right to wander. Please feel free to add your comments and experiences!

Sunday, December 10, 2006

Blood Pressure (My latest Ask Dr Peg column)

Dear Dr. Peg,

While shopping at my local Smith's store, I stopped by the pharmacy to measure my blood pressure. The machine told me that it was 127/75. Is this a healthy blood pressure? Also, what's the relationship between blood pressure and cholesterol levels? What can I do to maintain a healthy blood pressure?

Dear Smith’s guy,

The short answers to your questions are: probably, nothing, and plenty. But I’m not one for short answers, so pull up a chair.

What exactly is blood pressure? It is the amount of pressure that your blood exerts on your blood vessels, from within them. You might liken it to air pressure in your tires, or water pressure in your pipes.

Air pressure is measured in PSI’s, or pounds per square inch. Blood pressure is measured in mmHg, or millimeters of mercury. This is because blood pressure cuffs originally used a vertical column of mercury to measure pressure. A pressure reading of 100 meant the mercury column was pushed up (against gravity) 100 millimeters.

There are two numbers in a blood pressure reading, the top number and the bottom number. Basically they are maximum and minimum readings. The top number,127 for you, is the systolic (say “siss-TALL-ick”) blood pressure. This is the pressure present in the arteries during systole (SISS-toe-lee) , which is the active squeezing phase of the heart’s pumping action. The bottom number,75 for you, is the diastolic (say “dye-uh-STALL-ick”) blood pressure. This is the pressure present in the arteries during diastole (dye-ASS-toe-lee) which is the inactive, relaxation phase of the heart.

What is normal for blood pressure? Pretty much anything less than 120/80 and still standing. Too low is when you pass out because of it. A person’s blood pressure changes throughout the day, depending on many factors. Your blood pressure is lowest when you are asleep, and highest when you are exercising strenuously.

If your blood pressure always reads between 120-140 systolic and/or 80-90 diastolic you could have pre-hypertension, meaning you could be at risk for developing the disease of Hypertension, or high blood pressure. In the pre-hypertension range, lifestyle changes like losing weight, exercising more, and eating less salt are often all that’s needed to bring your blood pressure down to normal.

If you get repeated readings with a systolic pressure over 140 and/or a diastolic over 90, you may have Hypertension. This is a bad thing. Imagine what would happen if you filled your bike tires with as much air pressure as you put in your car tires. Ka-blam, right? That’s what happens in your tiny blood vessels if they get too much pressure. The result is damage to all your organs, especially your heart, kidneys and brain.

What can you do to keep your blood pressure in a healthy range? Maintain a normal weight. Exercise regularly. Don’t smoke. Limit your alcohol intake, or don’t drink. Minimize your stress, or manage it as best you can.

Hypertension is sometimes genetic. If it runs in your family, you can decrease your chance of getting it by following the advice above, and by getting a professional blood pressure measurement once a year, during your yearly physical.

Blood pressure and cholesterol are not directly related to each other. High blood pressure doesn’t cause high cholesterol or vice versa. However, they both contribute to the same health problems (heart attacks, strokes, organ damage) and each alone can kill you. It behooves you to keep both blood pressure and cholesterol as low as possible. Beyond that, cholesterol is a topic for another day.

Finally, a word about supermarket blood pressure machines. Take them with a grain of –oops, I mean, they may not be exactly accurate. To maximize your chances of an accurate reading, rest first for ten minutes, then put your bare arm into the machine. If you get worrisome or wildly differing readings in Smiths, come in to the StudentHealthCenter and let the professionals check it. Call ###-#### for an appointment.

16 comments:

I am a 59-year-old retired US Army master sergeant. I was compelled to start my site to alert unsuspecting patients that have been told they need a coronary bypass that you probably don't. I was told by an invasive cardiologist in April 2004, that my heart was in great shape, but I needed a quintuple bypass. Why, I wondered is my heart doing so good when the vessels that feed it oxygen are all clogged? Despite being told I needed surgery right away and that I was a walking time bomb, I got a second opinion and I am glad I did. Not only did I save myself from getting my chest cracked open in a major surgery, I saved a lot of money. PLEASE, get a second opinion whenever someone wants to give you a bypass. And read the entire blog.

Throughout my life I've had doctors asking me if I'm an athlete because my blood pressure is about 90 over something. Sometimes it goes up to about 100. My father is the same way. Thanks for your post, Peg.

I noticed that you posted a reply to Dr.A’s blog about MRSA being found on cultures from cellulitis. In Aug 2006 I was admitted to hospital with cellulitis at the front of my leg that grew rapidly (about 7 days) from almost nothing to 12cm by 12cm that had spread and caused a blood infection. I was told that I had MRSA but all cultures come back with something ... as this is part of the natural skin flora and doesn’t usually cause a problem for healthy people. My immune system is not compromised in any way and I never get colds or flu or stomach bugs and it is very unusual for me to be so ill. I was given IV antibiotics in August and the original cellulitis cleared in three weeks.

However, within two weeks of my discharge, the same rapidly spreading cellulitis formed at the back of my leg 12cm by 12cm. I have taken many different antibiotics intermittently since August and I have been in constant agony. The consultant at the hospital confirmed that I have a new variant of MRSA that is different from the original strain.

http://i66.photobucket.com/albums/h250/Carly_Cameron/P1020273.jpg

http://i66.photobucket.com/albums/h250/Carly_Cameron/P1020275.jpg

These pics were taken on 3rd January 2007. The cellulitis occupies the indented flesh at the base of my calf muscle and sits on the swollen anklebone. As the cellulitis flares up so does the swelling of the anklebone and foot. Sometimes, the calf muscle swells, also.

If the current lot of oral antibiotics does not cure this infection, my family doc has intimated that there is nothing more he can do. I have been prescribed Potassium Permanganate pills to dissolve in a bucket of water and I must soak the leg for 20 mins. I have managed to endure this treatment (once a week) because the yellow and turquoise coloured exudates seem to stop for a few days, but the stinging is quite terrible for a couple of days. I think the infection has remained the same size (instead of growing little by little) whilst taking this treatment.

I have also been prescribed flamazine cream and fucidin (fusidic acid) cream that acted like a topical painkiller, but allowed the infection to spread rapidly. I have ordered Medihoney from the Internet and this appears to control the pain and the infection. Honey is currently being researched for skin disorders. I can recommend this because it has worked where chemicals have failed.

http://www.garlic.mistral.co.uk/Allicin.htm

I am also researching allicin. I wonder if you know anything about this? Garlic has a good reputation for protecting the heart.

http://www.allstarhealth.com/f/futurebiotics-echinacea_immune.htm

I’m also researching Echinacea but having little joy with any worthwhile findings.I have ordered herbal pills that strengthen the immune system. This is what is in each pill. I shall order some goji berries later, also. This is my only avenue of hope.

Guggul

Guggul is a resin known to increase white blood cell counts and possess strong disinfecting properties. Guggul has long been known to normalize lipid metabolism, lower cholesterol and triglycerides, while maintaining or improving the HDL to LDL ratio. It may have been one of the very first "broad spectrum drugs" with a wide therapeutic range. A broad mode of action makes this plant very helpful not only in protecting against the common cold, but also in various skin, dental and ophthalmic infections. Guggul promotes general defense mechanism of the body through increased white blood cell production.

Guduchi

Guduchi has been proven to be effective in inhibiting the growth of bacteria and enhancing the buildup of immune resistance. Scientific research is now providing clues to Guduchi's immune-boosting ability to fight diseases. In a study using human white blood cells, Guduchi increased the killing ability of macrophages, the immune cells responsible for fighting invaders.

Indian Madder Indian Madder is considered the best Ayurvedic blood-purifying herb. In Ayurvedic medicine, it is used as an immune regulator. Its antioxidant properties are also being investigated. Indian Madder's role in supporting heart health is evidenced by studies that show that it regulates blood pressure, blood vessel constriction and the tendency of blood to form clots.

Amalaki (also known as Amla) is referred to in ancient text as the best medicine to prevent aging. It is a very strong rejuvenative which is believed to be the richest natural source of antioxydant vitamin C, with up to 720 mg/100g of fresh pulp or up to 900 mg/100g of pressed juice (of a heat-stable form which does not lose its value through processing.) Although only one inch in diameter, the Amalaki fruit has the same antiscorbutic value as two oranges. Amalaki is a proven immune function booster and is also effective against respiratory complaints.

Horseradish Tree Horseradish Tree contains a physiologically active constituent that has been shown to be effective in a broad range of health needs. For example, it contains 'Pterygospermin', an antibiotic-like substance.

Licorice Licorice is a versatile medicine in both India and China and has been primarily used to promote gastrointestinal health. It is a mild laxative which soothes and tones the mucous membranes and relieves muscle spasms. Clinical studies have proven Licorice extracts to be as effective as many synthetic alternatives. Licorice is rich in flavonoids and is currently under intense investigation as an antioxidant and as a cancer-protecting botanical boosting certain immune functions such as interferon production. Its mode of action is as an anti-mutagen, which prevents damage to genetic material.

Sorry for going on and on, but having been thru so much pain, I want to pass something positive to other sufferers when I return to health. In my Health Service, pain is a taboo subject. So is ward cleanliness. Bleach is a dirty word, so are soap and water. The word MRSA is whispered very fast so that you have to lip-read. A good 25% of patients taking up an acute bed should not have been in hospital. Some admitted to fooling the doctors into believing they were ill. One person had psoriasis and called an ambulance to take her to hospital and she was admitted. One patient concocted an illness whilst her house was being renovated. Nobody should go thru this hell because of inefficiencies and deficiencies.

Coral_P

www.coralpoetry.blogspot.com

When you have the time please could you reply to my blog above? Thank you. I have comment moderation checked so it will take a while to show.

Coral - one thing we have been doing at my clinic is treating patients with recurring MRSA abscesses and their families with daily nasal Bactroban antibiotic, in an attempt to eradicate the germ from the family. Other than that, we've had really good luck with Bactrim or Doxycycline. But we're outpatient only, don't see the tough cases like yours.

This is a repost of a reply which was posted on Tuesday, 9th January 2007.

Now 'anonymous' for personal reasons.

Thank you so very much for reading my post here and for visiting and perusing my poems.

You are correct: there is no post (as yet) about my cellulitis because the picture looks gloomy at present. I made an unhelpful, whining post plus a poem back in August when this cellulitis started; but my situation has run downhill since then.

As I discover what works for me and what does not (and there have been a heck of a lot of FDA approved drugs that have had terrible adverse reactions on my body, some of which were approved antibiotics, painkillers and hydrocolloid dressings) I shall create a new section at my blog that will be devoted to the results of various treatments (both herbal and chemical) and there will be a photo log as a diary of this bug.

I was wondering if you could post something in the future at your blog about resistant, persistent cellulitis cases (in general) as you discover them and what treatments have been helpful.

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The Authors of "50 Ways" Interview on KCHF TV

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About Me

Having been a clinic doc for twenty years, I've reached a point where I want to enrich my life and expand my skill horizons. Hence my creative writing efforts. So far successes include first place in the 2005 SouthWest Writer's Essay contest, co-authorship of a published book called 50 Ways to Leave Your 40s, and a regular health column in the Daily Lobo Newspaper.